What is Melasma?
Melasma is a common skin condition that is identified by light or dark patches of skin, which are brown-grey in colour. These discoloured patches are caused by the overproduction of melanin by melanocytes – the cells in our skin that produce the melanin that gives our skin its colour. Because of this, people who typically have more melanin are more prone to experience Melasma; Middle Eastern, Latin, Indian and Asian people have a higher risk. The risk is also far greater for women, as 90% of people who have Melasma are female. The most common type of this condition is pregnancy Melasma, which is known as Chloasma or pregnancy mask. Melasma is also influenced by hormonal changes, and most commonly appears in women aged 20 to 50.
Melasma typically affects the facial areas, commonly appearing around the central face, the cheekbones and the jawline. It can also appear around the neck, and less often, on the forearms. Melasma typically appears in symmetrical patterns, affecting both sides of the face equally.
What causes Melasma?
While the exact cause of Melasma is unknown, we do know that there are specific factors associated with its development. Factors that increase your risk of Melasma are:
This is the leading cause of Melasma. Exposure to the sun’s ultra violet radiation induces the formation of free radicals in the skin, which in turn stimulates your melanocyte cells to produce more melanin for more protection. And as we know, more melanin increases your likelihood of developing the condition, so it is best to avoid repeated UV exposure.
There are two kinds of hormonal changes that influence Melasma: internal and external. Internal hormonal changes during pregnancy, from increased levels of oestrogen and progesterone, are a common cause of Melasma. During pregnancy, the levels of oestrogen and progesterone increase, which affect the melanocyte-stimulating hormone (MSH), and so more melanin is produced by melanocytes. This especially occurs in the second and third trimesters of pregnancy. The good news is that pregnancy Melasma will usually fade away over the months following pregnancy.
The second hormonally related cause of Melasma is linked to external hormones like birth control pills and hormone replacement therapy (HRT). These both change the hormone levels in the body and have been known to cause Melasma in some women. Stopping the birth control pills and HRT can reduce this form of hyper-pigmentation.
Photo-toxic medicines or medications increase the sensitivity of the skin towards sun exposure, so using these medicines in combination with UV exposure greatly increases the risk of developing Melasma.
Genetic and family history
A genetic factor has been identified in more than 20% of people with Melasma. Those with a family history of Melasma are more likely to develop the condition, especially following sun exposure. The application of some cosmetic products can also exacerbate this risk. So if you have a family history of Melasma, it is best to avoid sun exposure, as well as the other factors listed above.
What are the types of Melasma?
There are three types of Melasma: epidermal, dermal and mixed. Melasma is categorised according to the distribution of melanin in the skin’s layers. The epidermal type is identified by the presence of excess melanin in the superficial layers of skin, and is generally tan-to-brown in color. Dermal Melasma is deeper in the dermis and is distinguished by its grey-to-greyish brown color. Mixed Melasma includes both the epidermal and dermal features. Epidermal Melasma is easier to treat as the pigments are on the surface of the skin and can be treated by topical treatments, but treating the dermal and mixed Melasma is more difficult and time-intensive.
What Melasma treatments are available?
There is a range of treatments for Melasma available, based on the causative factors and condition type. To confirm which type of Melasma you have, it is always best to get an expert opinion. The clinicians at Medix Skincare can confirm which type of treatment will be most effective for your skin. Treatment options include topical depigmenting agents and clinical treatments.
Effective treatments for epidermal Melasma are:
Cream, gel and lotion medicines are available to treat Melasma. The most popular of these is hydroquinone (HQ), which can be found in many over-the-counter products, however, a doctor’s prescription is needed for any HQ product with a concentration over 2%. Other popular options include non-hydroquinone topical medicines such as Azelaic acid, Retinoic acid and Tazaroten 0.5%-1%.
These are used to exfoliate the skin, and come in different varieties to suit different skin types. The most common peel is a glycolic acid peel. Chemical peels speed up the skin’s turnover and regeneration, and help remove the melanin deposits from the affected area. The type of peel should be tailored for each individual, as recommended by your skin therapist.
Microdermabrasion treatment works with vacuum suction and abrasion to exfoliate the top layers of the skin. It uses an abrasive material like fine diamond chips or aluminium oxide crystals. This resurfacing treatment has minimum to no side effects, and it can improve Melasma, however, it typically takes several treatments before results are seen. Multiple microdermabrasion treatments, when used alongside sunscreen and other topical creams or peels, can give excellent results.
Effective treatments for the more severe forms of Melasma, dermal Melasma and mixed Melasma, are:
For dermal and mixed Melasma, you will need prescribed hydroquinone with a concentration of over 2%. This can be acquired through a doctor’s prescription.
There is a range of different kinds of laser treatment available. Your skin therapist will choose the appropriate laser type based on your skin and its condition. A laser with a longer wavelength can penetrate the skin more deeply, and thus be more effective for treating dermal Melasma. Nd:YAG (1024 nm) and Q-Switched laser are examples of these types of laser, and are also safer for darker skin types. Another type of laser like pulsed dye laser (PDL) (510 nm) has a shorter wavelength and shallower penetration into the skin, so it is good for epidermal Melasma, however, it is not as safe as the lasers with longer wavelengths, so it is less commonly used for treating Melasma. If a therapist recommends PDL to you, we recommend getting a second opinion.
When considering your Melasma treatment options, make sure you talk to a qualified skin therapist who can offer safe and effective treatments. Your treatment should be tailored to your skin type, and take into account the cause factors. Our practitioners at Medix Skincare are always happy to offer advice, to ensure you receive safe treatment and the best outcome.
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